Calini Giacomo, Brollo Pier Paolo, Quattrin Rosanna, Bresadola Vittorio
Department of Medicine, General Surgery Department and Simulation Center, Academic Hospital of Udine, University of Udine, Udine, Italy.
Department of Organization of Hospital Services, Academic Hospital of Udine, Udine, Italy.
Front Surg. 2022 Feb 2;8:786158. doi: 10.3389/fsurg.2021.786158. eCollection 2021.
Currently, surgical drainage during a laparoscopic cholecystectomy (LC) is still placed in selected patients. Evidence of the non-beneficial effect of the surgical drain comes from studies with a heterogeneous population. This preliminary study aims to identify any clinical, demographic, or intraoperative predictive factors for a surgical drain placement during LC as the first step to identify population for a prospective randomized study.
The study was conducted in a single referral center and academic hospital between 2014 and 2018. Patients who underwent unconverted LC were divided into two groups: Group A (drain) and Group B (no drain). We explored baseline, preoperative, intraoperative characteristics, and postoperative outcomes.
Between 409 patients who underwent LC: 90 (22%) patients were in Group A (drain). Age >64 years, male sex, cholecystitis, Charlson comorbidity index (CCI) ≥ 1, experienced surgeon, intraoperative technical difficulties, need for an additional trocar, operative time >60 min, and estimated blood loss >10 ml were predictive factors at univariate analysis. While at multivariate analysis, cholecystitis (odds ratio [OR]: 2.8, 95% :1.5-5.1; < 0.001), CCI ≥ 1 (:1.9, 95% :1.0-3.5; = 0.05), intraoperative technical difficulties (: 3.6, 95% :1.8-6.2; < 0.001), need of an additional trocar (: 2.5, 95% : 1.4-4.4; < 0.005), and estimated blood loss >10 ml (: 3.0, 95% :1.7-5.3; < 0.0001) were predictive factors for a surgical drain placement during LC.
This study identified predictive factors that currently drive the surgeons to a surgical drain placement after LC. Randomized prospective studies are needed to define the use of drain placement in these selected patients.
目前，在腹腔镜胆囊切除术（LC）期间仍会对部分患者进行手术引流。手术引流无有益效果的证据来自针对异质性人群的研究。这项初步研究旨在确定LC期间进行手术引流的任何临床、人口统计学或术中预测因素，作为确定前瞻性随机研究人群的第一步。
该研究于2014年至2018年在一家单一的转诊中心和学术医院进行。接受未中转LC的患者被分为两组：A组（引流）和B组（未引流）。我们探究了基线、术前、术中特征及术后结果。
在409例行LC的患者中，90例（22%）患者属于A组（引流）。单因素分析时，年龄>64岁、男性、胆囊炎、Charlson合并症指数（CCI）≥1、经验丰富的外科医生、术中技术困难、需要额外的套管针、手术时间>60分钟以及估计失血量>10毫升是预测因素。而多因素分析时，胆囊炎（比值比[OR]：2.8，95%可信区间：1.5 - 5.1；P<0.001）、CCI≥1（OR：1.9，95%可信区间：1.0 - 3.5；P = 0.05）、术中技术困难（OR：3.6，95%可信区间：1.8 - 6.2；P<0.001）、需要额外的套管针（OR：2.5，95%可信区间：1.4 - 4.4；P<0.005）以及估计失血量>10毫升（OR：3.0，95%可信区间：1.7 - 5.3；P<0.0001）是LC期间进行手术引流的预测因素。
本研究确定了目前促使外科医生在LC后进行手术引流的预测因素。需要进行随机前瞻性研究来确定在这些选定患者中引流放置的使用情况。
